A review of the practice of requesting skull x-rays from the Emergency Department of St Luke’s Hospital

Background: In the Emergency Department (ED) of St. Luke's Hospital (SLH), head injuries are a common presentation. Although there are various guidelines which recommend approaches to the management of head injuries, these are not followed locally and the authors feel that a significant number of unnecessary skull x-rays (SXR) are being ordered by doctors. In this review we wished to observe the current trends in head injury investigations at the SLH ED and compare these with the NICE head injury guidelines. We also wanted to determine the impact that the NICE guidelines would have on these trends if they were to be instituted. Methods: The study is retrospective and observational. The demographics together with the rates of SXRs, CT scans and admissions were determined for patients presenting with head injury between the 1st of February and the 31st March 2006. The study also looked at the predicted rates had NICE guidelines been applied. Results: 387 patients were studied in a 2 month period. Of this total, only 2 patients (0.5%) had indications for a SXR but 312 patients (80.6 %) had this investigation. Out of this total of SXRs only 6 had positive findings (1.9%) and these went on to have a CT brain. A total of 72 patients had a CT scan of the head and of these 10 (13.9%) had positive findings. According to NICE guidelines 70 patients had indications for a CT. One hundred and twenty one patients (31.3%) were admitted, 201 were discharged (51.9%) and 65 patients (16.8%) discharged themselves against medical advice. Conclusion: The implementation of NICE guidelines would greatly reduce the rates of SXRs and hence reduce costs and radiation exposure. It also seems that the rates of CT scans will not change significantly.peer-reviewe

The Changing Epidemiology of Malaria in Ifakara Town, Southern Tanzania.

Between 1995 and 2000 there were marked changes in the epidemiology of malaria in Ifakara, southern Tanzania. We documented these changes using parasitological and clinical data from a series of community- and hospital-based studies involving children up to the age of 5 years. There was a right shift and lowering in the age-specific parasite prevalence in the community-based cohort studies. The incidence of clinical malaria in placebo-receiving infants in additional study cohorts dropped from 0.8 in 1995 to 0.43 episodes per infant per year in 2000, an incidence rate ratio of 0.53 (95% confidence interval: 0.404, 0.70, P<0.0001). At the same time, there was an increase in the total number of malaria admissions and a marked right shift in the age pattern of these admissions (median age in 1995 1.55 years vs. 2.33 in 2000, P<0.0001). However, the burden of malaria deaths remained in infants. We discuss how these dramatic changes in the epidemiology of malaria may have arisen from the use of currently available malaria control tools. Caution is required in the interpretation of hospital-based data as it is likely to underestimate the impact of anaemia on mortality in the community, where most paediatric deaths occur. Even in low/moderate malaria transmission settings, where older children suffer most malaria episodes, targeting effective malaria control at infants may produce important reductions in infant mortality caused by malaria

Hospital-based alternatives to acute paediatric admission: a systematic review

Objective: To synthesise published evidence of the impacts of introducing hospital-based alternatives to acute paediatric admission. Design: Systematic review of studies of interventions published in English. Patients: Children with acute medical problems referred to hospitals. Interventions: Services provided in a hospital as an alternative to inpatient admission. Main outcome measures: Admission or discharge, unscheduled returns to hospital, satisfaction of parents and general practitioners, effects on health service activity and costs. Results: 25 studies were included: one randomised controlled trial, 23 observational or cross-sectional studies and one qualitative study. Many studies were of uncertain quality or were open to significant potential bias. About 40% of children attending acute assessment units in paediatric departments, and over 60% of those attending acute assessment units in A &#38; E departments, do not require inpatient admission. There is little evidence of serious clinical consequences in children discharged from these units, although up to 7% may subsequently return to hospital. There is some evidence that users are satisfied with these services and that they are associated with reductions in inpatient activity levels and certain hospital costs. Evidence about the impact of urgent outpatient clinics is very limited. Conclusions: Current evidence supports a view that acute paediatric assessment services are a safe, efficient and acceptable alternative to inpatient admission, but this evidence is of limited quantity and quality. Further research is required to confirm that this type of service reorganisation does not disadvantage children and their families, particularly where inpatient services are withdrawn from a hospital

Adult and paediatric mortality patterns in a referral hospital in Liberia 1 year after the end of the war

The aim of this study was to describe and analyse hospital mortality patterns after the Liberian war. Data were collected retrospectively from January to July 2005 in a referral hospital in Monrovia, Liberia. The overall fatality rate was 17.2% (438/2543) of medical admissions. One-third of deaths occurred in the first 24h. The adult fatality rate was 23.3% (241/1034). Non-infectious diseases accounted for 56% of the adult deaths. The main causes of death were meningitis (16%), stroke (14%) and heart failure (10%). Associated fatality rates were 48%, 54% and 31% respectively. The paediatric fatality rate was 13.1% (197/1509). Infectious diseases caused 66% of paediatric deaths. In infants <1 month old, the fatality rate was 18% and main causes of death were neonatal sepsis (47%), respiratory distress (24%) and prematurity (18%). The main causes of death in infants > or =1 month old were respiratory infections (27%), malaria (23%) and severe malnutrition (16%). Associated fatality rates were 12%, 10% and 19%. Fatality rates were similar to those found in other sub-Saharan countries without a previous conflict. Early deaths could decrease through recognition and early referral of severe cases from health centres to the hospital and through assessment and priority treatment of these patients at arrival

Changing characteristics of hospital admissions but not the children admitted—a whole population study between 2000 and 2013

Funding: The data were hosted in the safe haven thanks to funding by the FARR institution. Open Access via Springer Compact Agreement.Peer reviewedPublisher PD

Systematic review of the safety of medication use in inpatient, outpatient and primary care settings in the Gulf Cooperation Council countries

Background Errors in medication use are a patient safety concern globally, with different regions reporting differing error rates, causes of errors and proposed solutions. The objectives of this review were to identify, summarise, review and evaluate published studies on medication errors, drug related problems and adverse drug events in the Gulf Cooperation Council (GCC) countries. Methods A systematic review was carried out using six databases, searching for literature published between January 1990 and August 2016. Research articles focussing on medication errors, drug related problems or adverse drug events within different healthcare settings in the GCC were included. Results Of 2094 records screened, 54 studies met our inclusion criteria. Kuwait was the only GCC country with no studies included. Prescribing errors were reported to be as high as 91% of a sample of primary care prescriptions analysed in one study. Of drug-related admissions evaluated in the emergency department the most common reason was patient non-compliance. In the inpatient care setting, a study of review of patient charts and medication orders identified prescribing errors in 7% of medication orders, another reported prescribing errors present in 56% of medication orders. The majority of drug related problems identified in inpatient paediatric wards were judged to be preventable. Adverse drug events were reported to occur in 8.5–16.9 per 100 admissions with up to 30% judged preventable, with occurrence being highest in the intensive care unit. Dosing errors were common in inpatient, outpatient and primary care settings. Omission of the administered dose as well as omission of prescribed medication at medication reconciliation were common. Studies of pharmacists’ interventions in clinical practice reported a varying level of acceptance, ranging from 53% to 98% of pharmacists’ recommendations. Conclusions Studies of medication errors, drug related problems and adverse drug events are increasing in the GCC. However, variation in methods, definitions and denominators preclude calculation of an overall error rate. Research with more robust methodologies and longer follow up periods is now required.Peer reviewe

Electric Scooter Injuries and Hospital Admissions in the United States, 2014-2018.

This study investigates trends of injury and hospital admission associated with electric scooter use